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Posted: 4/16/2024 11:45:13 PM EDT
In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide. In 2022, Ryerse's South Lincoln Medical Center was forced to shutter its operating room because it didn't have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed. Ryerse said the publicly owned facility's revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming. South Lincoln's financial woes aren't unique, and the risk of hospital closures is an immediate threat to many small communities. "Those cities dry out," Ryerse said. "There's a huge sense of urgency to make sure that we can maintain and really eventually thrive in this area." A recently released report from the health analytics and consulting firm Chartis paints a clear picture of the grim reality Ryerse and other small-hospital managers face. In its financial analysis, the firm concluded that half of rural hospitals lost money in the past year, up from 43% the previous year. It also identified 418 rural hospitals across the United States that are "vulnerable to closure." Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at the University of North Carolina, said the report's findings weren't a surprise, since the financial nosedive it depicted has been a concern of researchers and rural health advocates for decades. The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn't. |
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Posted: 4/16/2024 11:48:00 PM EDT
[#1]
Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients.
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Posted: 4/16/2024 11:48:26 PM EDT
[#2]
I reckon those execs are still making $400k-$1 mil a year though
 Funny how hospital districts are usually taxpayer supported, yet this kind of thing happens. |
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AZ, USA
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Posted: 4/17/2024 12:01:23 AM EDT
[#3]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? |
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AZ, USA
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Posted: 4/17/2024 12:03:25 AM EDT
[#4]
ARFcom loves to bloviate about the moral superiority of people who "live rural" but when those rural areas are having their economies hollowed out they cheer it on rather than try to stop it.
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WV, USA
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Posted: 4/17/2024 12:04:59 AM EDT
[#5]
Quote HistoryOriginally Posted By HIMARS13A: ARFcom loves to bloviate about the moral superiority of people who "live rural" but when those rural areas are having their economies hollowed out they cheer it on rather than try to stop it. |
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WA, USA
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Posted: 4/17/2024 12:06:23 AM EDT
[#6]
Living in BFE ain't for everybody.
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WY, USA
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Posted: 4/17/2024 12:07:06 AM EDT
[#7]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. |
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TX, USA
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Posted: 4/17/2024 12:07:42 AM EDT
[#8]
Can't make enough money if there are too many healthy people or not enough sick people?
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Posted: 4/17/2024 12:07:42 AM EDT
[#9]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Wow. You have no idea about how much pressure rural hospitals relieve off of bigger hospitals, or any clue that the number of patient beds to population is shrinking, or that the number of doctors per capita is dwindling rapidly. All massive contributing factors to even shittier care at major hospitals. |
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AZ, USA
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Posted: 4/17/2024 12:10:59 AM EDT
[#10]
FWIW, the way to keep these hospitals open is for local employers (city and county governments, especially) to contract directly with the hospital and bypass insurance. The hospital keeps more money and the employer can save up to 50% of their healthcare spend.
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AZ, USA
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Posted: 4/17/2024 12:11:29 AM EDT
[#11]
Quote HistoryOriginally Posted By ChuckD05: I mean, she could have it in a bathtub, or bring back midwives? Like we didn't have children before hospitals. That's some serious hillbilly bullshit. |
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USA
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Posted: 4/17/2024 12:11:52 AM EDT
[#12]
This isn’t limited to just rural healthcare systems. It’s a combination of many factors including but not limited to a population that is regressing in health, an increasing population of undocumented patients, temp labor nursing, all while trying to recover from Covid-19 where more hospitals had shut down electoral surgeries for months. Thats just the surface.
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LA, USA
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Posted: 4/17/2024 12:18:23 AM EDT
[Last Edit: killstick_engaged]
[#13]
Quote HistoryOriginally Posted By bayouhazard: Can't make enough money if there are too many healthy people or not enough sick people? You need staff to bill for services. They don't have staff. Couple things mentioned already CEO and admin probably make tons of cash still Providers who provide actual services (physicians, PAs, and since it's Wyoming, nurse practitioners) are not incentivize to work there because the pay for them is shit. Even though they and the taxpayer are the primary ones whose work keeps the lights on. Donald Trump and his cabinet figured this out and tried to get NPs and PAs better reimbursement. It's always the same song and dance with these 'failing' places. They want money but don't want to incentivize people to work there because it involves paying money to make money. Note how the article touts medicaid expansion at the end , once more putting the burden on the taxpayer while not actually solving any problems. Pay actual providers more and they will come. God forbid admin take a pay cut tho |
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Posted: 4/17/2024 12:19:28 AM EDT
[#14]
we keep taking them over here in Ohio, further and further away from central Ohio.
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Posted: 4/17/2024 12:22:14 AM EDT
[#15]
Quote HistoryOriginally Posted By 49north: Living in BFE ain't for everybody. Walk int any ER right now they are full, and the staff exhausted. Try to call a specialist for an appointment that is bothering you so bad your taking pain pills for, days off work, it serious for you--only to get told by the receptionist that the next available appointment is 6 months away. |
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Posted: 4/17/2024 12:22:44 AM EDT
[#16]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Ok smart guy, riddle me this. I did a med school rotation in rural Alaska. The hospital served an area about the size of Oregon. How long do you think it's reasonable for them to travel (often by snowmobile) for a hospital? |
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Posted: 4/17/2024 12:23:40 AM EDT
[Last Edit: Lomshek]
[#17]
The report noted that small-town hospitals in states that expanded Medicaid eligibility have fared better financially than those in states that didn't. And there’s the real reason for the report. They want every state to adopt Medicaid expansion which is an integral part of the original Obamacare plan to lock people into dependency on government and drive private insurers out of business. As an added bonus it drives patients into the arms of federally funded community health clinics as one step closer to 100% government run healthcare. Their reimbursement rate after expansion increases by around 130% while hospitals stays flat. |
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LA, USA
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Posted: 4/17/2024 12:27:02 AM EDT
[Last Edit: killstick_engaged]
[#18]
Quote HistoryOriginally Posted By 13starsinax: True. When I decided to move out into the woods I asked all the important questions about medical services etc. One problem is that the amount of people who said fuck cities and moved out here with me. They are overwhelming all the local hospitals with stuff they should see their primary care physician for. Walk int any ER right now they are full, and the staff exhausted. Try to call a specialist for an appointment that is bothering you so bad your taking pain pills for, days off work, it serious for you--only to get told by the receptionist that the next available appointment is 6 months away. FL should probably be friendlier to NPs and PAs and employ more of them with less restrictions. With millions more people thanks to unfettered border jumping and illegal aliens they will be needed like it or not, unless we can somehow sneeze them all out of the country. As I said before even Donald Trump himself was very favorable to those professions. I'm sure he was aware of the demographic nightmares we are heading towards, even without the last several years of illegal aliens coming in. That said the report just wants more communism |
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Posted: 4/17/2024 12:30:01 AM EDT
[#19]
Quote HistoryOriginally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. We are laughing. Lmao. |
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AZ, USA
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Posted: 4/17/2024 12:30:06 AM EDT
[#20]
Quote HistoryOriginally Posted By Lomshek: And there’s the real reason for the report. They want every state to adopt Medicaid expansion which is an integral part of the original Obamacare plan to lock people into dependency on government and drive private insurers out of business. As an added bonus it drives patients into the arms of federally funded community health clinics as one step closer to 100% government run healthcare. Their reimbursement rate after expansion increases by around 130% while hospitals stays flat. The difference between you and me is that I don't give a fraction of a fuck about private insurers. I'd just as soon live in an all cash world. Today I took a patients $179 urine test bill and I called the company that did the labs and I got them to reduce the price to under $20. With very few exceptions, if it isn't ortho, cardio or oncology, it's better to simply pay cash. So what you should be thinking about is how to make rural hospitals work WITHOUT government money. |
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Posted: 4/17/2024 12:30:41 AM EDT
[Last Edit: MikeJGA]
[#21]
Quote HistoryOriginally Posted By HIMARS13A: Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? Midcap thinks she should just squat down, pop out the kid and get back to work. Of course, the infant mortality rate used to be tremendous. |
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Posted: 4/17/2024 12:32:38 AM EDT
[Last Edit: Bourbonator]
[#22]
I can't speak for all rural hospitals, but ours is run by a moron who won't listen to his CMO or clinic director. It's such a shitshow.
ETA: Originally Posted By HIMARS13A: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? Well, our hospital doesn't have an ob-gyn and only keeps 6 units of blood on hand, so yes, a mother in labor should go elsewhere. |
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AZ, USA
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Posted: 4/17/2024 12:43:19 AM EDT
[#23]
Quote HistoryOriginally Posted By Bourbonator: I can't speak for all rural hospitals, but ours is run by a moron who won't listen to his CMO or clinic director. It's such a shitshow. ETA: Well, our hospital doesn't have an ob-gyn and only keeps 6 units of blood on hand, so yes, a mother in labor should go elsewhere. OB wards are closing all over because reimbursements are too low. |
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Posted: 4/17/2024 12:44:07 AM EDT
[#24]
Quote HistoryOriginally Posted By HIMARS13A: Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Let me get this straight, you think when a woman has a baby she should be flown to a hospital somewhere else in the state? Have tge baby at home. Or have tge ambulance take her to tge right facility. If uou need a birthing clinic, have a birthing g clinic. Doesn't need to be a hospital. |
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Posted: 4/17/2024 12:44:56 AM EDT
[#25]
Quote HistoryOriginally Posted By HIMARS13A: That's some serious hillbilly bullshit. My sons wife had both of their babies in a inflatable bathtub in a birthing center. No pain meds and went home with the babies in about 5-6 hours. Both perfectly healthy and much cheaper than a hospital. IIRC combined price was cheaper than one birth in a hospital.  |
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WY, USA
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Posted: 4/17/2024 12:46:21 AM EDT
[#26]
Quote HistoryOriginally Posted By HIMARS13A: OB wards are closing all over because reimbursements are too low. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By Bourbonator: I can't speak for all rural hospitals, but ours is run by a moron who won't listen to his CMO or clinic director. It's such a shitshow. ETA: Well, our hospital doesn't have an ob-gyn and only keeps 6 units of blood on hand, so yes, a mother in labor should go elsewhere. OB wards are closing all over because reimbursements are too low. And the required insurance to offer that service is incredibly expensive! |
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AZ, USA
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Posted: 4/17/2024 12:48:21 AM EDT
[#27]
Quote HistoryOriginally Posted By SARS: And the required insurance to offer that service is incredibly expensive! Bigger issue is finding a doctor that will do it. Rural FM with OB or OBGYN can make like $500k, and you need several so they can cover 24/7. |
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Posted: 4/17/2024 12:48:48 AM EDT
[#28]
Quote HistoryOriginally Posted By SARS: Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. Quote HistoryOriginally Posted By SARS: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. One, 2hr transport by ground is not unheard of. Two, rural hospitals barely "stabilize" patients. Three, there are fixed wing assets for transport as well. Rural community hospitals & hospitals in general are already heavily subsidized. No top notch surgeon or doctor will go. No one's going to place critical care assets there. You will get P.A's and be happy about it. |
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OH, USA
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Posted: 4/17/2024 12:48:56 AM EDT
[#29]
They should close the ERs and operate scheduled in-patient care/surgeries only in addition to outpatient services.
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AZ, USA
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Posted: 4/17/2024 12:49:00 AM EDT
[#30]
Quote HistoryOriginally Posted By FreefallRet: Lol My sons wife had both of their babies in a inflatable bathtub in a birthing center. No pain meds and went home with the babies in about 5-6 hours. Both perfectly healthy and much cheaper than a hospital. IIRC combined price was cheaper than one birth in a hospital. Good for her. What would have happened if she needed a doctor? |
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Posted: 4/17/2024 12:50:30 AM EDT
[#31]
Quote HistoryOriginally Posted By phatmax: Wow. You have no idea about how much pressure rural hospitals relieve off of bigger hospitals, or any clue that the number of patient beds to population is shrinking, or that the number of doctors per capita is dwindling rapidly. All massive contributing factors to even shittier care at major hospitals. Quote HistoryOriginally Posted By phatmax: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Wow. You have no idea about how much pressure rural hospitals relieve off of bigger hospitals, or any clue that the number of patient beds to population is shrinking, or that the number of doctors per capita is dwindling rapidly. All massive contributing factors to even shittier care at major hospitals. Actually, I do. And they aren't releasing shit. For major hospitals. Except for maybe rehab spots. Rural are shipping daily all critical care or acute care to cities. |
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USA
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Posted: 4/17/2024 12:51:52 AM EDT
[#32]
Might have to cut admin salaries or reduce the number of sinecures given out to the wives and children of connected people. Shame.
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Posted: 4/17/2024 12:51:56 AM EDT
[#33]
Quote HistoryOriginally Posted By HIMARS13A: That's some serious hillbilly bullshit. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By ChuckD05: I mean, she could have it in a bathtub, or bring back midwives? Like we didn't have children before hospitals. That's some serious hillbilly bullshit. You're very ignorant. Babies are constantly born at birthing ce ters & homes with midwives. In cities. |
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AZ, USA
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Posted: 4/17/2024 12:53:40 AM EDT
[#34]
Quote HistoryOriginally Posted By skid2041: You're very ignorant. Babies are constantly born at birthing ce ters & homes with midwives. In cities. I have a sister that was a waterbirth. That doesn't mean that you can just pop out kids 5 hours from the nearest hospital. |
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WI, USA
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Posted: 4/17/2024 12:55:26 AM EDT
[#35]
Fire all administration. Plenty of money saved to restructure and promote from within.
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Posted: 4/17/2024 12:56:06 AM EDT
[#36]
Quote HistoryOriginally Posted By NotIssued: Ok smart guy, riddle me this. I did a med school rotation in rural Alaska. The hospital served an area about the size of Oregon. How long do you think it's reasonable for them to travel (often by snowmobile) for a hospital? Quote HistoryOriginally Posted By NotIssued: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Ok smart guy, riddle me this. I did a med school rotation in rural Alaska. The hospital served an area about the size of Oregon. How long do you think it's reasonable for them to travel (often by snowmobile) for a hospital? Well, if that's all they got, that all they got. Smart guy. You gotta do what you gotta do. Right? Also, depends on their condition. How about this Mr Doctor. Why don't you start seeing patients at their homes? That would be horrible, right? Can't have you out of your sterile environment. They must come to you so you can bill properly. Right?. |
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UT, USA
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Posted: 4/17/2024 12:56:42 AM EDT
[#37]
Because nobody pays
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AZ, USA
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Posted: 4/17/2024 12:57:31 AM EDT
[Last Edit: HIMARS13A]
[#38]
Quote HistoryOriginally Posted By skid2041: Well, if that's all they got, that all they got. Smart guy. You gotta do what you gotta do. Right? Also, depends on their condition. How about this Mr Doctor. Why don't you start seeing patients at their homes? That would be horrible, right? Can't have you out of your sterile environment. They must come to you so you can bill properly. Right?. There are rural doctors doing house calls. It's not even that expensive. ETA: Insurance doesn't pay for it, of course. |
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Posted: 4/17/2024 12:59:42 AM EDT
[#39]
Quote HistoryOriginally Posted By HIMARS13A: They call an ambulance to transport to a hospital. Happened everyday all over the country. Good for her. What would have happened if she needed a doctor? Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By FreefallRet: Lol My sons wife had both of their babies in a inflatable bathtub in a birthing center. No pain meds and went home with the babies in about 5-6 hours. Both perfectly healthy and much cheaper than a hospital. IIRC combined price was cheaper than one birth in a hospital. They call an ambulance to transport to a hospital. Happened everyday all over the country. Good for her. What would have happened if she needed a doctor? |
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Posted: 4/17/2024 1:01:07 AM EDT
[#40]
Quote HistoryOriginally Posted By HIMARS13A: I have a sister that was a waterbirth. That doesn't mean that you can just pop out kids 5 hours from the nearest hospital. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By skid2041: You're very ignorant. Babies are constantly born at birthing ce ters & homes with midwives. In cities. I have a sister that was a waterbirth. That doesn't mean that you can just pop out kids 5 hours from the nearest hospital. Why not? You DONT need a hospital to give birth. That's a 20th century commodity. Dr used to come ro the actual birth. |
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Posted: 4/17/2024 1:01:31 AM EDT
[#41]
Quote HistoryOriginally Posted By HIMARS13A: There are rural doctors doing house calls. It's not even that expensive. ETA: Insurance doesn't pay for it, of course. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By skid2041: Well, if that's all they got, that all they got. Smart guy. You gotta do what you gotta do. Right? Also, depends on their condition. How about this Mr Doctor. Why don't you start seeing patients at their homes? That would be horrible, right? Can't have you out of your sterile environment. They must come to you so you can bill properly. Right?. There are rural doctors doing house calls. It's not even that expensive. ETA: Insurance doesn't pay for it, of course. Exactly. |
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COL
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Posted: 4/17/2024 1:05:54 AM EDT
[#42]
When half the staff is Admin of course they are loosing money every year.
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WY, USA
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Posted: 4/17/2024 1:15:48 AM EDT
[#43]
Quote HistoryOriginally Posted By skid2041: One, 2hr transport by ground is not unheard of. Two, rural hospitals barely "stabilize" patients. Three, there are fixed wing assets for transport as well. Rural community hospitals & hospitals in general are already heavily subsidized. No top notch surgeon or doctor will go. No one's going to place critical care assets there. You will get P.A's and be happy about it. Quote HistoryOriginally Posted By skid2041: Originally Posted By SARS: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. One, 2hr transport by ground is not unheard of. Two, rural hospitals barely "stabilize" patients. Three, there are fixed wing assets for transport as well. Rural community hospitals & hospitals in general are already heavily subsidized. No top notch surgeon or doctor will go. No one's going to place critical care assets there. You will get P.A's and be happy about it. So if all the ambulances are transporting people (4 hours round trip, and remember that is in good weather), who is going to respond to calls? How many ambulances would be required? Who is going to pay the EMS staff? Fixed wing transport is also often unavailable due to weather in the Rockies, and I imagine in other places like Alaska. My critical access hospital has the ER staffed by board certified EM docs, and the hospitalists are all experienced American MDs. If every maybe-sick patient is getting flown or driven to the major hospitals they are going to be overwhelmed quickly. The urban hospital I used to work in routinely had patients holding for days in the ER or some other location like a pre-op bay. I can't imagine increasing the volume by a large amount. |
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Posted: 4/17/2024 1:22:49 AM EDT
[#44]
Quote HistoryOriginally Posted By SARS: So if all the ambulances are transporting people (4 hours round trip, and remember that is in good weather), who is going to respond to calls? How many ambulances would be required? Who is going to pay the EMS staff? Fixed wing transport is also often unavailable due to weather in the Rockies, and I imagine in other places like Alaska. My critical access hospital has the ER staffed by board certified EM docs, and the hospitalists are all experienced American MDs. If every maybe-sick patient is getting flown or driven to the major hospitals they are going to be overwhelmed quickly. The urban hospital I used to work in routinely had patients holding for days in the ER or some other location like a pre-op bay. I can't imagine increasing the volume by a large amount. Quote HistoryOriginally Posted By SARS: Originally Posted By skid2041: Originally Posted By SARS: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. One, 2hr transport by ground is not unheard of. Two, rural hospitals barely "stabilize" patients. Three, there are fixed wing assets for transport as well. Rural community hospitals & hospitals in general are already heavily subsidized. No top notch surgeon or doctor will go. No one's going to place critical care assets there. You will get P.A's and be happy about it. So if all the ambulances are transporting people (4 hours round trip, and remember that is in good weather), who is going to respond to calls? How many ambulances would be required? Who is going to pay the EMS staff? Fixed wing transport is also often unavailable due to weather in the Rockies, and I imagine in other places like Alaska. My critical access hospital has the ER staffed by board certified EM docs, and the hospitalists are all experienced American MDs. If every maybe-sick patient is getting flown or driven to the major hospitals they are going to be overwhelmed quickly. The urban hospital I used to work in routinely had patients holding for days in the ER or some other location like a pre-op bay. I can't imagine increasing the volume by a large amount. Sorry to break it to you. But that happens in EMS systems daily. You just have to wait. "Staff by Board certified EM Dr" that's great. But, do you want the cardiothoracic to do a CABG on your heart that's done 1 every few months? Or the one that's done 6 CABGs daily for the last 6 months. Dr's are people to. Patie t contacts and seeing disease process & Patho matter. Which why level 1 Trauma centers are attached ro med schools.... see sick people matter. I'm sure the little hospital does its best and is great at many things. But I'm still going to the bigger hospital. Which can still fuck me up just as bad. But I will play the odds. |
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AZ, USA
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Posted: 4/17/2024 1:27:14 AM EDT
[#45]
Quote HistoryOriginally Posted By skid2041: Why not? You DONT need a hospital to give birth. That's a 20th century commodity. Dr used to come ro the actual birth. That's available for cash payers. Not going to happen with insurance patients. |
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Posted: 4/17/2024 1:34:44 AM EDT
[#46]
Quote HistoryOriginally Posted By HIMARS13A: That's available for cash payers. Not going to happen with insurance patients. Quote HistoryOriginally Posted By HIMARS13A: Originally Posted By skid2041: Why not? You DONT need a hospital to give birth. That's a 20th century commodity. Dr used to come ro the actual birth. That's available for cash payers. Not going to happen with insurance patients. I know plenty of insurance patients that have home births. |
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AZ, USA
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Posted: 4/17/2024 1:38:02 AM EDT
[#47]
Quote HistoryOriginally Posted By skid2041: I know plenty of insurance patients that have home births. Did the physician make money or lose money? Or are you talking about midwives again? |
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Posted: 4/17/2024 1:38:52 AM EDT
[Last Edit: dtux]
[#48]
I'm not sure if it's been everyone's experience or not, but the last few weeks we've received approximately one full ream of paper notifying us that folks we've seen are no longer with the hospital our insurance has us going to.
Some might read that as sarcasm, but I sincerely mean a full a ream. Every day for the last few weeks I've opened the mail box to find at least one hefty envelope filled to the brim with notifications that *So-and-So* we saw is no longer with the hospital. It's getting a bit weird 
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IA, USA
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Posted: 4/17/2024 1:39:15 AM EDT
[#49]
Hospital Administrators are Leaches the entire operation could run without them.
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WY, USA
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Posted: 4/17/2024 1:40:07 AM EDT
[#50]
Quote HistoryOriginally Posted By skid2041: Sorry to break it to you. But that happens in EMS systems daily. You just have to wait. "Staff by Board certified EM Dr" that's great. But, do you want the cardiothoracic to do a CABG on your heart that's done 1 every few months? Or the one that's done 6 CABGs daily for the last 6 months. Dr's are people to. Patie t contacts and seeing disease process & Patho matter. Which why level 1 Trauma centers are attached ro med schools.... see sick people matter. I'm sure the little hospital does its best and is great at many things. But I'm still going to the bigger hospital. Which can still fuck me up just as bad. But I will play the odds. Quote HistoryOriginally Posted By skid2041: Originally Posted By SARS: Originally Posted By skid2041: Originally Posted By SARS: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. Kemmerer mentioned in the story is at least 2 hours by ground from a significant hospital. And that is in decent weather. While you're onto something with the small hospitals closer to major hospitals, there are large chunks of the country that depend on rural hospitals to provide much of the care, or at least stabilize the patients while transport is arranged (and weather windows open). Flying everyone around (even if there were magical birds that aren't on hold much of the time like around here) would be extraordinarily expensive vs. taking them to the local ER where labs, imaging, etc. can often rule out the conditions for which patients would need to go to a major hospital. For example, an initial stroke workup, or chest pain workup, often can lead to discharge of the patient following appropriate diagnostics. It is more common for patients to be transferred straight from the emergency department of the rural hospitals than for patients to get admitted and then transferred, though it does happen, especially when initially no hospital agrees to receive the patient or transport is unavailable. Rural hospitals are a critical lifeline for much of the country. Could reforms be made to be more cost effective and promote better care? Sure, but outright elimination of them is a horrible idea. One, 2hr transport by ground is not unheard of. Two, rural hospitals barely "stabilize" patients. Three, there are fixed wing assets for transport as well. Rural community hospitals & hospitals in general are already heavily subsidized. No top notch surgeon or doctor will go. No one's going to place critical care assets there. You will get P.A's and be happy about it. So if all the ambulances are transporting people (4 hours round trip, and remember that is in good weather), who is going to respond to calls? How many ambulances would be required? Who is going to pay the EMS staff? Fixed wing transport is also often unavailable due to weather in the Rockies, and I imagine in other places like Alaska. My critical access hospital has the ER staffed by board certified EM docs, and the hospitalists are all experienced American MDs. If every maybe-sick patient is getting flown or driven to the major hospitals they are going to be overwhelmed quickly. The urban hospital I used to work in routinely had patients holding for days in the ER or some other location like a pre-op bay. I can't imagine increasing the volume by a large amount. Sorry to break it to you. But that happens in EMS systems daily. You just have to wait. "Staff by Board certified EM Dr" that's great. But, do you want the cardiothoracic to do a CABG on your heart that's done 1 every few months? Or the one that's done 6 CABGs daily for the last 6 months. Dr's are people to. Patie t contacts and seeing disease process & Patho matter. Which why level 1 Trauma centers are attached ro med schools.... see sick people matter. I'm sure the little hospital does its best and is great at many things. But I'm still going to the bigger hospital. Which can still fuck me up just as bad. But I will play the odds. I'm sure you know a patient needing a CABG is going to be transferred to an appropriate center. Depending upon presentation and availability, he will quite possibly be flown directly to an appropriate center from the field. The reality is that is a tiny fraction of the patients seen, regardless of whether you're in an urban ER or BFE. The role of the rural hospital is not to replace experienced subspecialists. It is to identify those patients who need them, vs. those who need to be discharged and told to follow-up in the appropriate clinic, perhaps with a few new meds to take in the mean time. Rural hospitals can address many of the more common problems in an efficient and convenient location. Does an ASA 1 or 2 patient having a lap appy or chole really need to be flown to a major hospital? |
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